Vital NHS reforms are casualties of bad management

WHICH politician said this about the NHS last year?

“We don’t want to privatise it, we want to break it up.” He’s a man who has consistently believed that the NHS needs major reform. As he put it in 2005: “I think breaking up the NHS is exactly what you do need to do to make it a more responsive service.” And he’s the same man who, when the Government’s NHS reform package was presented to Parliament in January, defended it with all his powers of persuasion: “What it seeks to do is something incredibly simple, which is make sure that patients are right at the centre of the NHS; that their wishes and their needs are absolutely the guiding principle of the decisions that are taken.

And that’s why we’ve asked the people who know the patients best – the GPs – to play a greater role in deciding where that patient goes, where the money goes in the system.” Nick Clegg – it’s him – has never been the man to depend on when you want a reliable ally. The Deputy Prime Minister, who was more than happy a few weeks ago to claim credit for the ideas, has now become their number one critic. Mr Clegg now calls them “bad” – a “disruptive revolution”.

But the row which has developed around the NHS reforms is not about their merit. It’s about Nick Clegg saving his job as Lib Dem leader. Mr Clegg has always been part of a small group within his party that is serious about reform. Now that he is so damaged, battered by the AV referendum result and the Lib Dems’ awful local election results, he has performed a swift volte face on NHS reform to pander to his activists. Step back from politics, however, and this is a mess neither Mr Clegg nor the Government ought ever to have been in.

And the person at fault here isn’t Nick Clegg, it’s Andrew Lansley. The Health Secretary has done the most inept job imaginable at selling his reforms to the public and is now a dead man walking. It is a matter of when, not if, he is removed from his job. He is, in large measure, the author of his own misfortune, His case is gold-plated; his presentation of it utterly flawed. Because Mr Lansley’s reforms are exactly what’s needed for the NHS – although you’d never know it from the tone of the debate.

The NHS may be what Nigel Lawson once called the English religion but it is an anachronism. Set up in 1948 in an era of open rationing, its fundamental problem isn’t simply that it is unable to satisfy demand. It’s that it is a top-down service, where patients are supplicants before the rationing authorities and Byzantine bureaucracy and are supposed to be grateful for what they are given. And such a system is wrong not just because it doesn’t fit the modern consumer society but, more fundamentally, because it is deeply inefficient, cannot guarantee an adequate level of basic care and wastes billions of pounds.

On any measure its productivity is appalling. For years we were told that the basic problem was that the NHS was under-resourced. The last government conducted a very expensive experiment to test that thesis, throwing billion after billion at the NHS. Between 1995 and 2009 spending on the NHS soared from £38billion a year to £111billion, a 7.9 per cent average annual rise, far more than even the NHS’s most committed advocates ever hoped for. The result has been shocking. Much of that money was effectively poured down the drain. The Office for National Statistics calculated last month that although services improved – they could hardly not have with so much spending – productivity declined by 2.7 per cent, an annual average fall of 0.2 per cent. Unforgivable waste.

Indeed, the Organisation for Economic Co-operation and Development says that, of 29 members (all the main economies of the world), only the Greek and Irish health systems are more inefficient. Mr Lansley’s proposed reforms are straightforward. The Government agreed to keep NHS spending at these record levels. But rather than throwing good money after bad, the reforms would have GPs decide how and where it should go. GPs, who meet patients and understand their needs, are to be given the power of the purse strings to buy what is needed. And instead of being forced to buy from one provider – the existing NHS – they will be able to choose from other organisations.

And that, effectively, is that. It’s a model that we all recognise in our daily lives. Competition and choice are the drivers of standards and value in almost every sphere – including, in other countries, health. A third of hospitals in France and Switzerland aren’t run by the state – the figure is two-thirds for German hospitals. Patients have real choice. In the NHS, only three per cent is spent by non-state providers. And all the countries with real competition and choice have far better outcomes and value for money than the NHS.

That’s what the health reforms are about. But instead of making clear their simplicity, and the motivation of prolonging rather than destroying the NHS, Mr Lansley has used jargon and become bogged down in pointless detail. Instead of pointing out why so much of the opposition within the NHS is simply the usual story of vested interests attacking anything which undermines them, he has resorted to gobbledygook.

So if – when – the reforms collapse, to appease the Lib Dems, Mr Lansley will have to shoulder the blame. Which is a terrible irony, given that he is the one man in the Cabinet who clearly knows what needs to be done.